Characteristics of Breath Sounds

Physical Findings in Selected Chest Disorders (cont’d)
Condition
Atelectasis
(Lobar Obstruction)
When a plug in a
mainstem bronchus (as
from mucus or a foreign
object) obstructs air
flow, affected lung
tissue collapses into an
airless state.
Pleural Effusion
Fluid accumulates in the
pleural space, separates
airfilled lung from the
chest wall, blocking the
transmission of sound.
Pneumothorax
When air leaks into the
pleural space, usually
unilaterally, the lung
recoils from the chest
wall. Pleural blocks
transmission of sound.
Percussion
Note
Dull over the
airless area
Dull to flat over
the fluid
Hyperresonanat
Or tympanitic
over the pleural
air
Trachea
May be shifted
toward
involved side
Shifted toward
opposite side in
a large effusion
Shifted toward
opposite side if
much air
Breath Sounds
Usually absent when
bronchial plug persists.
Exceptions include right
upper lobe atelectasis,
where adjacent tracheal
sounds may be
transmitted.
Decreased to absent, but
bronchial breath sounds
may be heard near top of
large effusion
Decreased to absent over
the pleural air
Adventitious
Sounds
None
None, except a
possible pleural rub
None, except a
possible pleural rub
Tactile Fremitus
and Transmitted
Voice Sounds
Usually absent
when the bronchial
plug persists. In
exceptions, e.g.,
right upper lobe
atelectasis, may be
increased
Decreased to
absent, but may be
increased towards
the top of a large
effusion.
Decreased to
absent over the
pleural air